Artificial intelligence's suggestions for level of amputation in diabetic foot ulcers are highly correlated with those of clinicians, only with exception of hindfoot amputations.

Diabetic foot ulcers (DFUs) are a growing public health problem, paralleling the increasing incidence of diabetes. While prevention is most effective treatment for DFUs, challenge remains on selecting the optimal treatment in cases with DFUs. Health sciences have greatly benefited from the integration of artificial intelligence (AI) applications across various fields. Regarding amputations in DFUs, both literature and clinical practice have mainly focused on strategies to prevent amputation and identify avoidable risk factor. However, there are very limited data on assistive parameters/tools that can be used to determine the level of amputation. This study investigated how well ChatGPT, with its lately released version 4o, matches the amputation level selection of an experienced team in this field. For this purpose, clinical photographs from patients who underwent amputations due to diabetic foot ulcers between May 2023 and May 2024 were submitted to the ChatGPT-4o program. The AI was tasked with recommending an appropriate amputation level based on these clinical photographs. Data from a total of 60 patients were analysed, with a median age of 64.5 years (range: 41-91). According to the Wagner Classification, 32 patients (53.3%) had grade 4 ulcers, 16 patients (26.6%) had grade 5 ulcers, 10 patients (16.6%) had grade 3 ulcers and 2 patients (3.3%) had grade 2 ulcers. A one-to-one correspondence between the AI tool's recommended amputation level and the level actually performed was observed in 50 out of 60 cases (83.3%). In the remaining 10 cases, discrepancies were noted, with the AI consistently recommending a more proximal level of amputation than what was performed. The inter-rater agreement analysis between the actual surgeries and the AI tool's recommendations yielded a Cohen's kappa coefficient of 0.808 (SD: 0.055, 95% CI: 0.701-0.916), indicating substantial agreement. Relying solely on clinical photographs, ChatGPT-4.0 demonstrates decisions that are largely consistent with those of an experienced team in determining the optimal level of amputation for DFUs, with the exception of hindfoot amputations.

The Ocular Prosthesis: A Novel Technique Using Digital Photography.

Loss of an eye can cause a significant psychological and emotional disturbance to any patient. An ocular prosthesis helps to re-establish the physical and mental well-being of the patient. This article describes a novel technique along with a case report for fabricating a predictable, esthetic and well-fitting custom-made ocular prosthesis in an attempt to avoid costly and time consuming procedures that may be required in other methods.

Evaluation of automated photograph-cephalogram image integration using artificial intelligence models.

OBJECTIVES: To develop and evaluate an automated method for combining a digital photograph with a lateral cephalogram. MATERIALS AND METHODS: A total of 985 digital photographs were collected and soft tissue landmarks were manually detected. Then 2500 lateral cephalograms were collected, and corresponding soft tissue landmarks were manually detected. Using the images and landmark identification information, two different artificial intelligence (AI) models-one for detecting soft tissue on photographs and the other for identifying soft tissue on cephalograms-were developed using different deep-learning algorithms. The digital photographs were rotated, scaled, and shifted to minimize the squared sum of distances between the soft tissue landmarks identified by the two different AI models. As a validation process, eight soft tissue landmarks were selected on digital photographs and lateral cephalometric radiographs from 100 additionally collected validation subjects. Paired t-tests were used to compare the accuracy of measures obtained between the automated and manual image integration methods. RESULTS: The validation results showed statistically significant differences between the automated and manual methods on the upper lip and soft tissue B point. Otherwise, no statistically significant difference was found. CONCLUSIONS: Automated photograph-cephalogram image integration using AI models seemed to be as reliable as manual superimposition procedures.

Use of digital retinography to detect vascular changes in pre-diabetic patients: a cross-sectional study.

BACKGROUND: Diabetic retinopathy (DR) is a common complication of DM and may go unnoticed until irreversible damage occurs. Its screening can contribute to the early detection. Although, there are no studies which investigate the ability of digital retinography to detect vascular changes in pre-diabetic patients. OBJECTIVE: Identify the prevalence and severity of RD in patients with pre-diabetes. METHODS: Cross-sectionalstudy carried out in a sample of patients with pre-diabetes and weight excess characterized from January 2020 to April 2023. Sociodemographic and clinical variables were collected, in addition to lifestyle habits. Retinographic evaluation was also performed using a Digital Retinography. For the analysis of all variables, the adopted significance level was 5%. The software used for the analysis was SPSS version 25.0. RESULTS: Of 108 patients selected 7.1% have alteration in the exam indicating DR. Among the participants with diabetic retinopathy, four had the moderate form (50%), three the moderate form (37%) and only one participant had the severe form (13%). CONCLUSIONS: Our findings highlight the importance of preventive measures and adequate control of these conditions in pre-diabetic patients, in order to prevent or delay the progression of diabetic retinopathy and, consequently, reduce the risk of blindness and other ocular complications.

A rapid assessment technique for coastal plastic debris sampling: Applications for remote regions and community science.

Marine debris is an environmental issue of increasing importance worldwide, with 80% of marine plastics estimated to originate from land-based sources. While much work has been conducted to quantify plastics in coastal environments, many of these approaches are site-specific and not amenable to rapid surveys. We surveyed beaches around Nova Scotia, Canada for plastic and other anthropogenic debris to: 1) quantify debris density on the high tide line; and 2) test a rapid survey technique using digital photos, with applications for community science and remote regions. Most (72%) beaches in Nova Scotia contained debris, but plastic densities along the daily high tide line were relatively low (mean 0.2 debris/m2) with little interannual variation. Despite small differences in plastic densities between observers, this rapid assessment technique appears viable for relative quantification and monitoring of plastic debris on beaches across large geographic scales to assess trends and sources.

Different Modalities to Record and Transfer Natural Head Position to Virtual Planning in Orthognathic Surgery: Case Reports of Asymmetric Patients.

AIM: To describe different modalities to record and transfer natural head position (NHP) to 3D facial imaging by using the virtual surgical planning software in three facial asymmetry patients. CASE REPORTS: Three patients with facial asymmetries (A, B, and C) were evaluated by means of dental and facial analysis, photographs, cone-beam computed tomography (CBCT) and digitized dental arches. Before starting the VSP workflow with Dolphin Imaging, NHP was recorded by three modalities and transferred to three-dimensional (3D) facial images as follows: (a) facial photographs taken with digital camera and the estimated NHP was transferred to 3D images by comparing lines and planes from both images; (b) cross-line level laser was used to place radiopaque markers on the face skin for recording the estimated NHP, which was transferred to 3D images by alignment of planes and markers in the software; and (c) photographs of the face were processed to generate facial surface mesh by using the Agisoft PhotoScan software, which maintained the same position of the estimated NHP in 3D for aligning the images of the soft tissue with the facial surface mesh by using superimposition. All the three patients underwent bi-maxillary orthognathic surgery. CONCLUSION: There are different modalities using simple and available technologies in the clinical routine, but whose reproducibility, reliability and validation could not be assessed nor compared to each other. There was no trend for better predictability, feasibility and efficiency because the postoperative outcomes were adequate regarding the patients' satisfaction and facial symmetry.

Feasibility of oral health evaluation by intraoral digital photography: a pilot study.

OBJECTIVES: This study investigated the accuracy and duration of intraoral digital photograph examination (IDPE) for evaluating oral health status and explored the feasibility of remote oral health assessment. METHODS: Thirty-one healthy college students underwent evaluations of oral health status via clinical examination (CE) combined with panoramic X-ray assessment at baseline, followed by IDPE 1 month later using photos taken at baseline. Methods for evaluation of gingival health included the Modified Gingival Index (MGI) and Plaque Index (PI). Examinations of caries status included the decayed, missing, and filled teeth and surfaces indexes (DMFT and DMFS indexes, respectively). The duration of each evaluation was also recorded. RESULTS: There were significant differences in MGI and PI between CE and IDPE. There were no significant differences in DMFT and DMFS indexes between CE and IDPE, and there were positive correlations between CE and IDPE for each of the two indexes (DMFT index: r=0.56; DMFS index: r=0.69). The IDPE duration was shorter than the CE duration. CONCLUSIONS: The feasibility of caries status assessment via IDPE is promising. Digital oral health evaluation merits further clinical consideration. TRIAL REGISTRATION: Xiamen University Training Program of Innovation and Entrepreneurship for Undergraduates, project number: 2018X0583. Registered 1 April 2018; http://cxw.xmu.edu.cn/admin/Innovation/NewInnovationDetail?id=6ce0a415-6131-496b-891a-6a1ae44e556d.

Accuracy of 3D reproduction of natural head position using three different manual reorientation methods compared to 3D software.

PURPOSE: The aim of this study was to analyze the positional differences of three-dimensional (3D) natural head positions (NHPs) reproduced by three different manual reorientation methods without special software by the Pose from Orthography and Scaling with ITerations (POSIT) method. METHODS: Five ceramic markers were attached to each of 12 patients' faces, and frontal and lateral photographs in the NHP and 3D computed tomography (CT) were taken. The 3D surface model was reoriented for the NHP reproduction by four different methods: the POSIT method (standard method), the location of the markers (A), the soft tissue landmarks (B) on the photographs, and manual correction without photographs (C). On each 3D surface model, the location of the skull was evaluated three-dimensionally. RESULTS: Differences between reproduced NHPs in each of the four different methods were statistically significant (p < 0.0001). Compared to the POSIT method, the accuracy of the other reproducing methods was lower. The A and B methods showed a similar accuracy to each other, while the C method presented the most inaccurate NHP. CONCLUSION: If 3D NHP reproduction using special software is impossible, reproducing NHP with photographs may be used as an alternative method, but its application should be clinically limited.

Quantitative light-induced fluorescence images and digital photographs - Reproducibility of manually marked demineralisations.

OBJECTIVE: Hard tooth tissue demineralisation is an undesirable side effect of orthodontic treatment with fixed appliances. Whereas both clinically and in digital photographs (DP), demineralisations appear as white spot lesions, WSLs appear as dark areas when quantitative light-induced fluorescence (QLF) imaging is used. This study aims at comparing the reproducibility of the detection of decalcified tooth areas in DP and QLF. MATERIALS AND METHODS: DP and QLF pairs were acquired from 139 teeth of 32 patients after braces removal. Three raters manually marked the decalcified area on both DP and QLF images. The markings were repeated after 2 weeks. A ground truth was estimated for each tooth and modality using the simultaneous truth and performance level estimation (STAPLE) algorithm. The Dice coefficients (DC) of each rater marking to the ground truth were calculated for all teeth and modalities to quantify the spatial agreement. A three-way repeated measures analysis of variance (ANOVA) was used to compare the means of the DCs for both modalities ([Formula: see text]). Intra-observer and intercycle variabilities were assessed comparing the means across the raters and the cycles for both modalities. RESULTS: ANOVA revealed a statistical significant difference between the modalities [[Formula: see text], [Formula: see text]]. The standard deviation of the DC for the photographs are lower than those for the QLF images. Intra-observer and intercycle differences are rather small as compared to the intermodality differences. CONCLUSIONS: The results indicate a higher spatial reproducibility in identifying a decalcified area on a tooth surface using visual inspection of DP rather than QLF images.

Features identification for automatic burn classification.

PURPOSE: In this paper an automatic system to diagnose burn depths based on colour digital photographs is presented. JUSTIFICATION: There is a low success rate in the determination of burn depth for inexperienced surgeons (around 50%), which rises to the range from 64 to 76% for experienced surgeons. In order to establish the first treatment, which is crucial for the patient evolution, the determination of the burn depth is one of the main steps. As the cost of maintaining a Burn Unit is very high, it would be desirable to have an automatic system to give a first assessment in local medical centres or at the emergency, where there is a lack of specialists. METHOD: To this aim a psychophysical experiment to determine the physical characteristics that physicians employ to diagnose a burn depth is described. A Multidimensional Scaling Analysis (MDS) is then applied to the data obtained from the experiment in order to identify these physical features. Subsequently, these characteristics are translated into mathematical features. Finally, via a classifier (Support Vector Machine) and a feature selection method, the discriminant power of these mathematical features to distinguish among burn depths is analysed, and the subset of features that better estimates the burn depth is selected. RESULTS: A success rate of 79.73% was obtained when burns were classified as those which needed grafts and those which did not. CONCLUSIONS: Results validate the ability of the features extracted from the psychophysical experiment to classify burns into their depths.

Three-dimensional natural head position reproduction using a single facial photograph based on the POSIT method.

We developed a new method to record and reproduce the three-dimensional natural head position (NHP) from a single photograph of a patient's face using a pose from orthography and scaling with iterations (POSIT) algorithm. We attached 4-mm spherical ceramic markers to the patient's face as feature points. A frontal photograph of the patient's NHP was taken using an ordinary digital camera parallel to the global horizon. Computed tomography (CT) was then performed on the patient with the markers. The ceramic marker positions were determined in the 2D image and corresponded to points in the 3D model. The 3D rotation matrix determined using the feature points via the POSIT method was applied to the CT model to reproduce the NHP. A skull phantom was used to evaluate the accuracy and reproducibility of the developed method. The degree difference (°) between the true and POSIT orientations in the roll, pitch, and yaw directions was quantified as the error. The mean accuracy was -0.04 ± 0.15°, -0.17 ± 0.50°, and -0.02 ± 0.37° in the roll, pitch, and yaw directions, respectively. The method developed was highly reproducible during intra-observer and inter-observer variation analyses. The accuracy of the method was clinically acceptable, and the procedure was time- and cost-effective. This method is accurate and inexpensive; additionally, it does not affect the patient's lip position, and we expect it to be routinely used during orthognathic surgery.